A heroin users cooks her shot in the bathroom of a Taco Bell in Denver.( Joe Amon, The Denver Post)

U.S. Department of Health and Human Services Secretary Sylvia Burwell, Gov. John Hickenlooper and his health cabinet met Thursday in Denver to bring focus to best practices for fighting opioid abuse.
“I’m spending time on the issue because here in Colorado and across the country people … don’t realize the costs in terms of lives, health and economics,” Burwell said. “The number of deaths that come from overdose is greater than the number of deaths that come from car accidents.”
HHS recently launched a bipartisan initiative to reduce prescription opioid and heroin abuse, overdose deaths and dependence. The president’s 2016 budget includes investments to intensify efforts, including $99 million in new funding.
“We recognize we still have a long way to go, but we’ve reduced abuse … and gone from being one of the worst states to middle of the pack,” Hickenlooper said during a brief press conference after an hour-long roundtable discussion with Burwell.
Colorado has attained results using best practices endorsed by HHS, Burwell said, which include the Prescription Drug Monitoring Program, a voluntary prescriber registry that tracks how many different sources for drugs a patient might be tapping.
And the state has liberalized laws to increase access to naloxone, an antidote to narcotics overdoses.
“This drug very effectively prevents death,” Burwell said. “Colorado again is taking the steps to lead in this.”
Burwell outlined other best practices, such as educating physicians and other prescribers on how to avoid over-prescribing opioid painkillers.
And she called for expanding the use of Medication-Assisted Treatment (MAT), comprehensively addressing substance abuse with medication, counseling and behavioral therapies.
Blair Hubbard, introduced by Burwell, said addiction treatment using medication (methadone) had saved her life. Her story of addiction was typical, she said. After being prescribed an opioid after minor surgery, she continued “to chase the feeling” when her prescription ran out. She bought it on the street and then switched to heroin, which is “stronger, cheaper and easier to get.”
In Colorado, Hickenlooper recently began a public awareness campaign called “Take Meds Seriously” to address the epidemic abuse of prescription drugs and the 35 deaths a month from unintentional overdoses.
Members of the governor’s health cabinet, representatives from the Colorado Consortium for Prescription Drug Abuse Prevention, representatives from Denver Health and other stakeholders joined Hickenlooper and Burwell for the roundtable discussion at Denver Health.

April 13, 2014 file photo, the Internal Revenue Service Headquarters (IRS) building is seen in Washington. (AP Photo/J. David Ake, File)

Coloradans reporting errors in the premium tax credits reported by the state health insurance exchanges are among 800,000 tax filers nationwide with the same problem, according to the Centers for Medicare and Medicaid Services.

The Internal Revenue Service is granting relief to taxpayers with incorrect tax forms 1095-A, which was supposed to provide the amount of the advance premium tax credits for those who purchased health insurance plans through the exchanges, including Connect for Health Colorado.

Michael Yearout, a Breckenridge photographer, was excited to purchase health insurance for his wife and himself in 2014 after going 10 years without it – especially because he has a heart condition.

Even though the plan he purchased from Rocky Mountain Health Plans through the exchange had a $10,000 deductible, he said he felt much more financially secure.

When his wife turned 65 in March and switched over to Medicare, Yearout canceled her coverage, he said. That led to the loss of what had been a generous premium tax credit for both, about $2,000 a month. The premium went up for his individual policy — it was higher than he had been paying for coverage for both.

“I couldn’t afford it,” Yearout said. “I had to cancel it.” Any and all policies should have been canceled by March, as Yearout had requested. But the family’s policy wasn’t.

Yearout turned 65 in December 2014 and was eligible for Medicare.

But when the exchange sent him a 1095-A tax form, it indicated he’d received the benefit of an advance premium tax credit – paid on his and his wife’s behalf to the exchange for the Rocky Mountain Health Plans premium for the entirety 2014 – about $24,000. He wasn’t really eligible for most of it, so that has to be repaid. But he shouldn’t be the one to repay it. He tried to cancel.

He’s been trying to clear up the error – even enlisting the Division of Insurance – without success, he said.

Aware of the problems nationawide, between February and May, the Department of the Treasury has notices of relief from tax penalties, expanding that relief as new kinds of 1095-A errors have surfaced.

On the IRS website: Those who filed their returns by April 15, but have since learned the form had incorrect information, under the relief provided, they don’t have to file an amended return – even if additional taxes would be owed based on the new information, the IRS reports.

The IRS said it won’t pursue additional taxes in those cases. If updated information is in the taxpayers’ favor, they can file an amended return. Taxpayers generally have up to three years from the date they filed their return, or two years from the date they paid the tax, whichever is later, to pay an amended return.

For filers who filed their taxes on time but didn’t send the payment because the 1095-A was in error, the IRS will issue a notice demanding payment. The taxpayer can respond to the notice with a letter containing the statement, “I am eligible for the relief granted under Notice 2015-9 because I received excess advance payment of the premium tax credit,” according to National Association of Tax Professionals TAXPRO Monthly. Interest still accrues for unpaid amounts, but the penalty is abated.

For those who were unable to file accurate tax returns by April 15, but who filed for extensions, the IRS is offering penalty relief.

Republicans on the Senate Business, Labor and Technology Committee Monday defeated a bill with a party-line 5-4 vote that would have protected patients from unexpectedly high, uncovered bills from doctors.

Bill opponents said it would give insurance companies unfair leverage in negotiations with health care providers.

Insurance plans pay differently for health care that is provided in-network vs. what they designate as out-of-network care. Even patients who choose to go to an in-network hospital or clinic to avoid these higher costs are sometimes treated by an unknown out-of-network provider and hit with surprise charges.

Sen. Irene Aguilar, a primary care physician, said she wrote Senate Bill 259 to protect patients against such practices, which critics equate with consumer fraud.

Family physician Robin Dickinson lobbied for the bill because, she said, even she was hit with these unexpected charges although she was knowledgeable about the issues and risks.

Dickinson suffered a tear in an artery in her neck that clotted and sent two clots to her brain causing two strokes, she said.

“I had high-deductible insurance so carefully watched all the bills that came in,” she said in emails to generate support for the bill. “The ER doctor and neurologists, who SAVED MY LIFE, billed a reasonable couple hundred dollars. But the hospitalist, who basically filled out paperwork (I’ve done his exact job numerous times myself and it’s not difficult or time-consuming), billed me $900!”

She said when she called his billing office she learned he was out of network. But it wasn’t her insurance company picking up the tab, she said. It was her responsibility.

“I had no idea that he was out of network, or I would have kicked him out of my room,” Dicksinson said. “I consider this fraud and manipulation.”

Aguilar described the bill’s augmented standards for disclosure as requiring providers to:

“Inform a patient seeking covered services at an in-network facility about legal protections against ‘balance billing.’ Balance billing is defined as billing a person with coverage the difference between what the insurance company pays and what the provider charges.

Inform the covered person that balance billing is possible if treatment comes from an out-of-network provider at an in-network facility.

The out-of-network provider must inform the patient that they are seeking treatment from an out-of-network provider. They must also provide the billing charges or an estimate to the patient on request, in writing.

The out-of-network provider may not ‘balance bill’ the patient, unless the person has agreed to pay the difference in advance.

Insurance carriers must provide written notice to their clients about their out-of-network obligations.

Emergency services are exempt from the bill.”

Yet the bill had some heavy-hitter opposition, including the Colorado Medical Society.

Opponents outlined the issues this way in the legislative alerts they circulated:

“The out-of-network provider, who doesn’t have a contract with the health plan, is required to submit a bill to the person’s health plan and not collect any payment from the patient, beyond deductibles, copayment and coinsurance, and is prohibited from any further balance billing of the patient.

Joshua Montoya on his 5th birthday with his Children’s Hospital Colorado Heart Institute doctors, Scott Auerbach and Max Mitchell. Montoya was airlifted in November 2013 from Albuquerque, NM to Children’s Colorado, where he spent months in the hospital connected to a Berlin heart pump before receiving a heart transplant in mid-June. He just went home to New Mexico Sept. 16. The ACE Kids Act will help kids with complex medical needs, like Montoya’s, to cross state lines to access specialized care (Photo courtesy of Children’s Hospital Colorado).

UPDATE: The U.S. Senate on March 24 adopted an amendment introduced by Sens. Michael Bennet, D-Colo., and Rob Portman, R-Ohio, to improve care for children with medically complex conditions who rely on Medicaid.

The Advancing Care for Exceptional Kids Act would allow health care providers to deliver services to kids with these complicated conditions through models that coordinate care between providers, improving results and lowering costs, Bennet said in a press release.

SEPT. 17, 2014
Children prematurely born and those with cancer, congenital heart disease, cystic fibrosis, Down syndrome and other complicated medical conditions have lifelong challenges that proposed federal legislation would try to make more manageable for families.

About two-thirds of the 3 million U.S. children with complex cases are covered by Medicaid. They make up only 6 percent of Medicaid child enrollees, yet they account for almost 40 percent of Medicaid costs for children, said Children’s Hospital Colorado chief executive Jim Shmerling.

Advances in health care have made it possible for many more of these children to survive these conditions. Yet many must first go from doctor to doctor to find answers and effective treatments. They often must leave their home states to get the specialized care they require at regional centers.

The proposed Advancing Care for Exceptional Kids Act of 2014, or ACE Kids, would provide for the creation of voluntary nationally designated children’s hospital networks to coordinate care for children with complex illnesses and disorders. Based on health needs and family preference, each child would be matched with a network anchored by a children’s hospital — it would help both families and providers across state lines, proponents say.

“These children receive fragmented care from multiple providers and duplicated tests, Shmerling said. “It’s a very expensive fragmented system. We need to reshape the delivery of their care.”

Bill supporters, which began with 10 children’s hospitals and now includes more than 60 hospitals, point to two commissioned actuarial studies showing the coordinated system they propose could cut Medicaid costs by 2 percent, saving $10 billion to $13 billion a year.

“This is certainly not a grab for market share,” he said. “It improves care and reduces costs.”

The Troop family from Bountiful, Utah, has adopted six children. Four of them have a rare connective-tissue disorder called epidermolysis bullosa, or EB, with skin so fragile that almost any friction or impact can cause blisters, wounds and scarring. It’s the same with the mucosal tissue lining their mouths, throats, eyes and affects organs.

A screen grab from Connect for Health Colorado website. (connectforhealthco.com)

State health insurance exchange officials released their 2014 annual report late Thursday and made a case to legislators they had a successful first full year of operations and that 2015 enrollment problems are manageable.

The exchange has increased Coloradans choices and access to health insurance and its affordability, Connect for Health Colorado officials said.

“We can do better,” interim chief executive Gary Drews said. “We’re still very much a start-up organization — basically a train heading down the track at a couple hundred miles an hour and still laying the track ahead of it.”

Appearing before a joint legislative committee on health and insurance issues late Thursday, Jan. 15, Drews said the exchange could be self-sustaining after remaining monies from $177.7 million in federal grants were used up in 2015.

Yet, he conceded, the board and managers clearly need to engage in strategic planning on how to achieve this.

Part of the 2015 strategic plan is to assess carriers a charge of $1.25 per policy per month in 2015. The exchange has statutory authority to charge up to $1.80, but the board chose not to last year or to charge the full amount this year.

Another revenue stream from operations is the 1.4 percent administrative fee charged carriers on premiums. It is currently among the lowest in the country, Drews said, and less than half that charged by the federal exchange, which is $3.50.

Drews reminded legislators he’s only been acting CEO for four months. The exchange board had interviewed eight candidates for the position by Thursday, and scheduled two more for Friday.

“We hope to be able to make an offer before the end of the month,” board chairman Sharon O’Hara said.

According to the annual report, the exchange signed up about 150,000 individual Coloradans and 335 small businesses in 2014. However, as of Dec. 31, there were 123,138 active policies. Some people had churned out of the system before year’s end.

About 58 percent of exchange enrollees received a tax credit — an average $262 a month. Their average premium for their selected plans would have cost $400 a month without it. People who purchased through the exchange without tax credits chose plans that cost, on average, of $287 a month.

Sen. Kevin Lundberg, R-Berthoud, chair of the Health and Human Services Committee, accused the exchange of “padding” its number in quoting the 150,000 figure rather than 123,138. Drews said the number is the one required by federal reports, and it speaks to overall volume and revenues gained from completed enrollments.

Lundberg also wondered if the claim was valid that Colorado’s uninsured rate in Colorado fell from 17 percent to 11 percent last year. What about, he asked, the 300,000 people whose insurance policies were canceled by carriers because they were non-compliant with the Affordable Care Act. Drews said it wasn’t known how many opted for other plans and what portion stayed uninsured, but the 11 percent net figure came from a statewide Gallup Poll, not from the exchange.

Drews talked about, but downplayed, the technical problems with the 2015 enrollment site that have frustrated consumers. They also necessitated an emergency infusion of $322,000 beyond what was budgeted to resolve about 1,900 outstanding problem tickets and provide workarounds for known technical glitches through February.

Jennifer Perkins, second from left, a broker from The Jen Perkins Agency, and Rachel Gips, second from right, a guide from the GLBT Community Center of Colorado, try to help customers as they figure out their options for health insurance. In the final week leading up to the March 31, 2014, deadline for signing up for health insurance through the Affordable Care Act. (Kathryn Scott Osler The Denver Post)

Connect for Health Colorado, the state health insurance marketplace, is touting its new and improved enrollment website for customers shopping for private health insurance.

Open enrollment under the Affordable Care Act begins Nov. 15 and runs through Feb. 15, 2015.

More than 148,000 individuals are covered through plans purchased on the Marketplace in 2014.

All this week, customers could compare policies offered in their area, research eligibility for tax credits, choose coverage and begin the enrollment process.

“We want to encourage consumers to comparison shop for policies that meet their needs and their own particular circumstances,” said interim CEO Gary Drews. “Monthly premiums, benefits and the financial assistance available to consumers who qualify can change each year. This year, there are some new, less expensive choices available in many regions. We are urging Coloradans to be smart consumers – and compare their options before renewing their current plan or enrolling in a new one.”

Applicants this year can use a single application process directing consumers to either complete enrollment in private health insurance through Connect for Health Colorado or with Medicaid with the state Department of Health Care Policy and Financing.

During open enrollment, other new features will roll out as ready including:

An Avatar/Guide named “Kyla,” a virtual assistant who can help customers through some key steps of the enrollment process.

A Medication Look-Up Tool, or formulary, which lets customers compare prescription coverage under various policies.

A Provider Directory to help customers check whether their doctor is in the network of a health plan.

Whether renewing or enrolling for the first time, exchange customers must complete enrollment by Dec. 15 to have coverage Jan. 1, 2015, and avoid a gap in insurance.

Huga Goto, at 2, looks at all the costumes while trick-or-treating last year during the Munchkin Masquerade on the Pearl Street Mall in Boulder. (Jeremy Papasso / Boulder Daily Camera)

The most common chronic disease of early childhood is tooth decay — five times more common than asthma.

Despite being largely preventable, tooth decay continues to plague children, especially those in lower-income families, even more in this last decade than before. At least 4 million U.S. preschoolers suffer with it.

In Colorado, 40 percent of kindergartners have had cavities, according to a 2012 report of the Colorado Department of Public Health and Environment.

So before your children head off to fill bags, buckets, pillow cases and totes with sugar-laden substances, here are some things to consider.

Wanjek says that candy isn’t the worst thing for your teeth. The most harmful factors are stickiness and acidity, so potato chips and fruit chews or leathers are actually worse than chocolate. Among candies, sour gummies are the worst for teeth, he says.

Pediatric dentist Dr. Elizabeth Shick with the CU School of Dental Medicine at the Anschutz Medical Campus agrees sticky or sour candies, or hard candies that stay in the mouth a long time, are the worst for teeth.

Besides the obvious recommendation — always brush before bedtime — Schick says set aside a special treat time each day so that children have a limited exposure instead of all-day candy eating. Consider having treat time shortly after mealtimes, she says, because saliva production increases during meals and helps neutralize bacteria production in the mouth and rinse away food particles.

Some things to consider year-round:

Even baby teeth cavities need to be filled, according to ChildrensDentalHealth.com. Untreated cavities can lead to pain, abscesses, spreading infection and long-term dental sensitivity. Baby or primary teeth that are healthy and present help with proper chewing and nutrition, speech development and they serve as better guides for erupting permanent teeth, the site says.

Really? Little tiny caries in teeth that are going to fall out anyway. Kids have to have all those filled? They do, according to Professor William Bailey with the University of Colorado School of Dental Medicine, who is he Delta Dental Endowed Chair in Early Childhood Caries Prevention.

“It’s important to get them fixed. They (caries) are easy to fix when they’re small,” Bailey said. Otherwise, if tooth decay really takes over, it could require later oral surgery. And early decay in children is the leading predictor of future decay.

Oral health is so important, Bailey said, that pediatricians and primary care physicians are all checking on it during the first well-child visit, which should happen by age 1.

The Affordable Care Act expanded dental coverage, and among the services that must now be covered at no cost by all health plans are: oral-health risk assessments by a pediatrician and application of fluoride varnish for children through age 5, which Bailey also recommends.

The act also gives state Medicaid programs the option of receiving a 1 percent increase in federal matching funds if states provide all the ACA services at no cost to patients. Colorado is one of 10 states that had chosen this option as of September.

Joshua Montoya on his 5th birthday with his Children’s Hospital Colorado Heart Institute doctors, Scott Auerbach and Max Mitchell. Montoya was airlifted in November 2013 from Albuquerque, NM to Children’s Colorado, where he spent months in the hospital connected to a Berlin heart pump before receiving a heart transplant in mid-June. He just went home to New Mexico Sept. 16. The ACE Kids Act will help kids with complex medical needs, like Montoya’s, to cross state lines to access specialized care (Photo courtesy of Children’s Hospital Colorado).

Children prematurely born and those with cancer, congenital heart disease, cystic fibrosis, Down syndrome and other complicated medical conditions have lifelong challenges that proposed federal legislation would try to make more manageable for families.

About two-thirds of the 3 million U.S. children with complex cases are covered by Medicaid. They make up only 6 percent of Medicaid child enrollees, yet they account for almost 40 percent of Medicaid costs for children, said Children’s Hospital Colorado chief executive Jim Shmerling.

Advances in health care have made it possible for many more of these children to survive these conditions. Yet many must first go from doctor to doctor to find answers and effective treatments. They often must leave their home states to get the specialized care they require at regional centers.

The proposed Advancing Care for Exceptional Kids Act of 2014, or ACE Kids, would provide for the creation of voluntary nationally designated children’s hospital networks to coordinate care for children with complex illnesses and disorders. Based on health needs and family preference, each child would be matched with a network anchored by a children’s hospital — it would help both families and providers across state lines, proponents say.

“These children receive fragmented care from multiple providers and duplicated tests, Shmerling said. “It’s a very expensive fragmented system. We need to reshape the delivery of their care.”

Bill supporters, which began with 10 children’s hospitals and now includes more than 60 hospitals, point to two commissioned actuarial studies showing the coordinated system they propose could cut Medicaid costs by 2 percent, saving $10 billion to $13 billion a year.

“This is certainly not a grab for market share,” he said. “It improves care and reduces costs.”

The Troop family from Bountiful, Utah, has adopted six children. Four of them have a rare connective-tissue disorder called epidermolysis bullosa, or EB, with skin so fragile that almost any friction or impact can cause blisters, wounds and scarring. It’s the same with the mucosal tissue lining their mouths, throats, eyes and affects organs.

A new TV ad unveiled recently by the conservative group Americans for Prosperity hits U.S. Sen. Mark Udall for the roughly 340,000 health insurance policy cancellations doled out to Coloradans since the implementation of the Affordable Care Act.

What do thousands of cancellations of Coloradan health insurance policies really mean?

The Colorado Division of Insurance has reported that there were about 2,100 health-plan cancellations in the state over the past two months, bringing this year’s total to more than 6,150.

The division reported the figures for June 15-Aug. 15 to Senate Minority Leader Bill Cadman last week. Senate Republicans have requested monthly updates of the numbers. Opponents of Obamacare have used the numbers to make the point that Coloradans continue to lose plans they want to keep.

Since 2013, there have been about 340,000 policy cancellations in Colorado. Many customers received notices last fall as the Affordable Care Act was rolling out. Policies that did not meet the act’s minimum standards were cancelled, though customers were offered replacement policies or early renewals so they could hang on to the non-compliant policies another year or two, until the state and feds finally ended the grace period.

Yet plan cancellations, before and after ACA, are also the result of business decisions by the insurers as part of normal operations. Because cancellation numbers weren’t tracked in the same way prior to the ACA, it’s difficult to compare before and after.

Opponents of the Affordable Care Act cite the cancellations as proof that it is hurting consumers more than helping. Yet the insurance division and the Colorado Association of Health Plans say cancellation figures, without more context, reveal little.

“This doesn’t mean these are people without insurance,” said division spokesman Vince Plymell. “They have a lot more options for insurance under the act.”

Carriers each year decide to drop plans for a number of legal or business reasons, including that they’re not compliant with the law or that they’re no longer popular with enough consumers or profitable for them, Plymell said.

DENVER, CO. – MARCH 15: A Connect for Health Colorado RV is parked outside Escuela Tlatelolco during a Latino enrollment event in Denver on March 15, 2014 in Denver, CO March 13, 2014. A coalition of groups teamed up to answer questions and offer assistance in healthcare enrollment. (Photo By Craig F. Walker / The Denver Post)

Health policy analysts at the Kaiser Family Foundation recently took a look at how four states, including Colorado, used different approaches to handle the challenges of setting up new health insurance marketplaces within the tight time frame under the Affordable Care Act.

All the state online exchanges and the federal website, HealthCare.gov, faced technological glitches and delays, the foundation found. Despite the challenges, said the report, released July 28, more than 8 million Americans enrolled in new private coverage, and Medicaid coverage grew by 6 million since just before the open enrollment period began in October.

The Kaiser brief highlighted the different approaches taken by four states they deemed success stories in terms of enrollment — Colorado, Connecticut, Kentucky and Washington.

Under the Affordable Care Act, states had the option of defaulting to the federal exchange or creating their own health insurance marketplaces offering health plans and premium tax credits to offset the cost of coverage. The act sought to require all states to expand Medicaid to nearly all adults with incomes at or below 138 percent of the federal poverty level ($27,310 for a family of three in 2014). But then the Supreme Court made Medicaid expansion an option for the states.

All four of the states the foundation looked at built their own exchanges and expanded Medicaid. All four states saw “significant” enrollment, the report states.

All four states used extensive marketing — television, print, radio, billboards and social media — to send “a straightforward message” about the availability of new coverage options, the study found. Among other messages, Connect for Health in Colorado launched a digital billboard that counted down the days left until the end of open enrollment March 31.

The states used a broad array of avenues to reach consumers: libraries, extension centers, grocery and discount stores, barber and beauty shops, college campuses, churches, small businesses, coffee shops, gyms and even people’s homes.

The exchanges used local events, such as fairs and sporting events, to reach large numbers of people. Colorado hosted group enrollment appointments at local schools and libraries. Marketplace staff in Colorado and Kentucky traveled across their states in branded RVs to spread the word. Colorado’s outreach teams spoke with more than 64,000 people in more than 230 locations, the report says.

The states also tried to customize brochures and other materials to reach specific audiences or communities — such as Colorado developing information that focused on the importance of coverage to address special health concerns of African Americans.

They also developed tip sheets and checklists to help people organize all the information they would need when they started their application.

Colorado and Connecticut set up walk-in enrollment sites at office buildings and street malls, among other places. In March, Colorado’s exchange opened five temporary walk-in enrollment sites staffed by Connect for Health Colorado and Medicaid agency staff, insurance brokers and enrollment “assisters.” They reported nearly 3,000 people received help at these sites during the three weeks they were open.

All four states’ exchange stakeholders agreed that one-on-one assistance with trusted individuals was one of the most important factors in getting people enrolled. Several different types of paid and volunteer “assisters” — called navigators in Colorado — supported outreach and enrollment events.

The states also plan to improve and enhance training for the assisters, although there about future funding for assisters.

The Colorado exchange trained and certified more than 1,500 insurance brokers and agents to work alongside the assisters who helped an individual complete the application. The broker would then help the individual choose a plan.

Electa Draper is the health writer for The Denver Post and has covered every news beat in a 22-year journalism career at three newspapers. She has a bachelor's degree in biology and a master's in journalism.